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Development and pilot intervention costs (explicit and implicit costs) Pilot I (n = 14) Pilot II (n = 16)
Source publication
The goal of this article is to improve the practice and reporting of cost estimates of prevention programs. It reviews the steps in estimating the costs of an intervention and the principles that should guide estimation. The authors then review prior efforts to estimate intervention costs using a sample of well-known but diverse studies. Finally, t...
Contexts in source publication
Context 1
... were assessed in terms of explicit and implicit costs. Table 4 shows the total costs and the costs per family for development and the pilot interventions. Somewhat surprisingly the costs of the pilot cohorts were no greater than those for subsequent cohorts. ...
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Citations
... In fact, many of these mental health programs are funded by the public administration. Given the budgetary constraints that are normally considered in the public sector, the financing of these programs depends increasingly on a positive outcome in the cost-benefit analysis [19]. ...
... The cost-benefit analysis was carried out in three consecutive phases (see Figure 2). In the first phase, we assessed the costs of implementing the program, following the methodology recommended by Foster et al. [19]. Following this method, first, the different types of resources that were required were identified. ...
Families going through conflictive divorce processes are at increased risk of developing mental health problems. The Egokitzen program is a group intervention for parents who have undergone a divorce process, funded by the public administration. Budgetary constraints cause funding institutions to be interested in the effectiveness and economic efficiency of these programs. Therefore, the objective of this research is to carry out an efficiency analysis of the Egokitzen program, implemented by family visitation centers in Spain, through a cost-benefit analysis, to determine whether the positive impact on symptomatology (measured using CBCL and SCL-90 instruments) is translated into a positive economic impact for society. A sample of 382 parents participated. Costs will be first identified and valued; secondly, benefits achieved with the program will be identified through a prevalence analysis and, finally, the cost-benefit comparative analysis will be carried out. Additionally, a sensitivity analysis will be performed. The results obtained in the analysis indicate that for every euro spent on this program, the public administration and society save 3.10 euros in future interventions through medical costs and productivity losses. The study has practical implications for public administration, organizations, and the family visitation centers that implement the program.
... Second, we focused on sensitivity and scenario analyses to determine the potential costs of our population health management approach if it were to be used by a healthcare system for recruitment and enrollment to a local program (not a clinical trial) that aligned with the CDC Diabetes Prevention Recognition Program requirements. The analytical approach followed the best practice guidelines for the costing of prevention interventions [34,35] and the modified cost assessment procedure proposed by Ritzwoller et al. [29], consisting of five elements: (a) perspective of the analysis, (b) identifying costs components, (c) capturing relevant costs, (d) data analysis, and (e) sensitivity analysis. ...
Limited research has reported the economic feasibility—from both a research and practice perspective—of efforts to recruit and enroll an intended audience in evidence-based approaches for disease prevention. We aimed to retrospectively assess and estimate the costs of a population health management (PHM) approach to identify, engage, and enroll patients in a Type 1 Hybrid Effectiveness-Implementation (HEI), diabetes-prevention trial. We used activity-based costing to estimate the recruitment costs of a PHM approach integrated within an HEI trial. We took the perspective of a healthcare system that may adopt, and possibly sustain, the strategy in the typical practice. We also estimated replication costs based on how the strategy could be applied in healthcare systems interested in referring patients to a local diabetes prevention program from a payer perspective. The total recruitment and enrollment costs were $360,424 to accrue 599 participants over approximately 15 months. The average cost per screened and enrolled participant was $263 and $620, respectively. Translating to the typical settings, total recruitment costs for replication were estimated as $193,971 (range: $43,827–$210,721). Sensitivity and scenario analysis results indicated replication costs would be approximately $283–$444 per patient enrolled if glucose testing was necessary, based on the Medicare-covered services. From a private payer perspective, and without glucose testing, per-participant assessed costs were estimated at $31. A PHM approach can be used to accrue a large number of participants in a short period of time for an HEI trial, at a comparable cost per participant.
... In school-based health interventions targeting HIV risk reduction, cost estimation is important as many interventions are moving out of the realm of efficacy studies. 20 Estimates of intervention cost inevitably require some modification as the programme is transported into community agencies; different inputs might be used or different prices might be paid for the same input. 20 Thus, a good understanding of inputs and their value is required. ...
... 20 Estimates of intervention cost inevitably require some modification as the programme is transported into community agencies; different inputs might be used or different prices might be paid for the same input. 20 Thus, a good understanding of inputs and their value is required. In this paper, an estimation of the cost of a school-based intervention for improving HIV risk perception among secondary school adolescents in Nigeria was conducted. ...
... These costs are especially reasonable when calculated on per-person and per-hour bases especially when compared to other cost estimated interventions. 20 This is because the costs of some intervention are higher than our current cost estimation for school-based intervention. 20,22 Jacobsen and Walensky 21 argued that studies on cost intervention demonstrate cost-effectiveness in HIV intervention but not all the interventions are affordable. ...
Early sexual debut is common in Nigeria and increases HIV risk among adolescents. About 152,000 adolescents are living with HIV. Lack of knowledge and appropriate sexual reproductive health services are some factors responsible. This paper estimated the cost of secondary school-based HIV/AIDS intervention for schools in Enugu State, Nigeria. The rationale for estimation is to avoid unaffordable and ineffective interventions. The cost was estimated between March to October 2019 for schools in urban and rural areas with a population of 1595 students. The cost estimation was aided through UNAID proposed guideline. The estimation was done by classifying the intervention into the cost of training, cost of services and cost of commodities. The cost was estimated at $5954. The estimated cost in the urban is lesser than that of rural.
Continuous....
... Second, we focused on sensitivity analysis to determine the potential costs of our PHM approach if it were to be used by a healthcare system for recruitment and enrollment to a local program (not a clinical trial) that aligned with the CDC Diabetes Prevention Recognition Program requirements. The analytical approach followed the best practice guidelines for the costing of prevention interventions [31,32] and the modi ed cost assessment procedure proposed by Ritzwoller et al. [26], consisting of ve elements: 1) perspective of the analysis, 2) identifying costs components, 3) capturing relevant costs, 4) data analysis, and 5) sensitivity analysis. ...
Background
Limited research has reported the economic feasibility—from both a research and practice perspective—of efforts to recruit and enroll an intended audience in evidence-based approaches for disease prevention. This study aims to retrospectively assess and estimate the costs of a population health management (PHM) approach to identify, engage, and enroll patients in a Type 1 Hybrid Effectiveness-Implementation (HEI), diabetes-prevention trial.
Methods
We used descriptive analyses and activity-based costing to estimate the recruitment costs of a PHM approach integrated within a HEI trial. Measures included total costs and costs per participant screened and enrolled to ensure trial accrual rates were achieved. We took the perspective of a healthcare system which may adopt, and possibly sustain, the strategy in the typical practice. We also estimated replication costs based on how the strategy could be applied in healthcare systems interested in referring patients to a local diabetes prevention program from a payer perspective. In this case, we examined differences in cost based on requirements for and types of, glucose testing, and by labor activities and non-labor resources associated with recruitment using sensitivity analyses.
Results
The total recruitment and enrollment costs were $389,949 to accrue 599 participants over approximately 15 months. The average cost per screened and enrolled participant was $276 and $651, respectively. Primary costs included hemoglobin A1c testing ($83,106), recruitment screening calls ($48,791), and personnel time ($96,187). Translating to the typical settings, total recruitment costs for replication was estimated as $192,625 (range: $42,523-$208,876). Sensitivity analysis results indicated replication costs would be approximately $229 - $430 per patient enrolled if glucose testing was necessary, based on the Medicare covered services. For a private payer perspective, and without glucose testing, per-participant screening and enrollment costs were estimated at $30.
Conclusions
A PHM approach can be used to accrue a large number of participants in a short period of time for an HEI trial, at a comparable cost per participant. However, when trial requirements are removed and PHM approaches are used as a method for healthcare systems to identify and enroll patients in a local program—the costs are relatively low.
... Comprehensive cost analyses of evidence-based programs can provide a foundation for adequate investment when programs are being considered for broad dissemination or smaller replication projects (Foster et al. 2007) and serve as a benchmark against which program impacts and return on investment can be evaluated. To support program investment capable of driving impact, this article presents a comprehensive cost analysis of an evidence-based, brief, tailored home visiting program known as the Family Check-up (FCU), which was delivered in the Early Steps multisite trial to high-risk families in three diverse locales for 4 consecutive years, beginning when target children were age 2. ...
High-quality evidence about the costs of effective interventions for children can provide a foundation for fiscally responsible policy capable of achieving impact. This study estimated the costs to society of the Family Check-up, an evidence-based brief home-visiting intervention for high-risk families implemented in the Early Steps multisite efficacy trial. Intervention arm families in three sites were offered 4 consecutive years of intervention, when target children were ages 2 through 5. Data for estimating total, average, and marginal costs and family burden (means and standard deviations, 2015 USD, discounted at 3% per year) came from a detailed database that prospectively documented resource use at the family level and a supplemental interview with trial leaders. Secondary analyses evaluated differences in costs among higher and lower risk families using repeated measures analysis of variance. Results indicated annual average costs of $1066 per family (SD = $400), with time spent by families valued at an additional $84 (SD = $99) on average. Costs declined significantly from ages 2 through 5. Once training and oversight patterns were established, additional families could be served at half the cost, $501 (SD = $404). On the margin, higher risk families cost more, $583 (SD = $444) compared to $463 (SD = $380) for lower risk families, but prior analyses showed they also benefited more. Sensitivity analyses indicated potential for wage-related cost savings in real-world implementation compared to the university-based trial. This study illustrates the dynamics of Family Check-up resource use over time and across families differing in risk.
... A detailed understanding of the inputs and costs of an intervention are needed to move from more controlled research settings to real-world implementation contexts. 10 Despite the importance of health intervention cost estimates, the inclusion and quality of these estimates are frequently lacking and seldom addressed in the literature. 9 11-13 Considerable effort and focus are often placed on the rigorous measurement of health outcomes of interventions, whereas methods for measuring intervention costs have been relatively neglected in comparison. ...
... Because data are collected on a micro-level to document the quantities of each resource used, sensitivity analyses can easily be employed to examine how intervention costs could change depending on contextual differences in resource use and resource unit costs. 10 For example, costs for inputs such as rent for facilities or certain costs of labour can easily be adjusted to account for potential differences in rents or wages across regions. 28 Researchers can also examine cost differences that may result from substituting inputs-such as capital for certain types of labour or using lower cost labour for certain activities-to help optimise efficiency. ...
... 28 Researchers can also examine cost differences that may result from substituting inputs-such as capital for certain types of labour or using lower cost labour for certain activities-to help optimise efficiency. 10 35 36 In general, when intervention costs are presented, resource unit quantities and unit costs should be presented separately to enhance the usefulness of results to inform future planning for replication and scale up by allowing other investigators to conduct similar types of sensitivity analysis. 10 21 37 An emphasis on this type of transparency and assessment of contextual factors can help a cost analysis align with and contribute to broader evaluation and planning priorities focused on facilitating the successful translation and dissemination of effective interventions, such as those described in the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. ...
Micro-costing data collection tools often used in literature include standardized comprehensive templates, targeted questionnaires, activity logs, on-site administrative databases, and direct observation. These tools are not mutually exclusive and are often used in combination. Each tool has unique merits and limitations, and some may be more applicable than others under different circumstances. Proper application of micro-costing tools can produce quality cost estimates and enhance the usefulness of economic evaluations to inform resource allocation decisions. A common method to derive both fixed and variable costs of an intervention involves collecting data from the bottom up for each resource consumed (micro-costing). We scanned economic evaluation literature published in 2008-2018 and identified micro-costing data collection tools used. We categorized the identified tools and discuss their practical applications in an example study of health interventions, including their potential strengths and weaknesses. Sound economic evaluations of health interventions provide valuable information for justifying resource allocation decisions, planning for implementation, and enhancing the sustainability of the interventions. However, the quality of intervention cost estimates is seldom addressed in the literature. Reliable cost data forms the foundation of economic evaluations, and without reliable estimates, evaluation results, such as cost-effectiveness measures, could be misleading. In this project, we identified data collection tools often used to obtain reliable data for estimating costs of interventions that prevent and manage chronic conditions and considered practical applications to promote their use.
... More specifically, it measures the average hours of care at network level by summing over all patients, the time the delivered service activities take per year. Based on these breakdowns of service processes into activities, average cost per patient are calculated by calculating activity based costs for these activities as on average delivered to patients [27]. Costs are adjusted by purchasing power parity (PPP) for 2011 [28]. ...
Background
While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian’s Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK.
Methods
Data collection consisted of: a) systematic modelling of provider network’s structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011–2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian’s SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes.
Results
The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year.
Conclusions
While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning.
... The process of understanding a program's resource needs continues to be one of the most consistently neglected yet addressable areas of program evaluation ( Crowley et al. 2012;Foster et al. 2007; National Academy of Medicine 2014). Cost analyses specify the resources required to repli- cate a program's effectiveness ( Gold et al. 1996). ...
... Cost analyses require considerable planning for effective ex- ecution (Beatty 2009). Retrospective analyses generally fail to capture all program costs due to gaps in the measurement of resources needed to implement the intervention and their prices ( Crowley et al. 2013;Foster et al. 2007). Prospective planning before a study starts allows evaluators to identify essential program activities, such as curriculum delivery or home visits, that consume resources. ...
... Each aspect of infrastructure involves resources and costs that may be substantial and variable across time (Crowley et al. 2012). All resources needed to build a successful pre- vention effort should be included in a comprehensive cost estimate of a program ( Foster et al. 2007). Sustaining an in- tervention is a complex undertaking that may involve system- ic issues far beyond a specific prevention program. ...
Over a decade ago, the Society for Prevention Research endorsed the first standards of evidence for research in preventive interventions. The growing recognition of the need to use limited resources to make sound investments in prevention led the Board of Directors to charge a new task force to set standards for research in analysis of the economic impact of preventive interventions. This article reports the findings of this group’s deliberations, proposes standards for economic analyses, and identifies opportunities for future prevention science. Through examples, policymakers’ need and use of economic analysis are described. Standards are proposed for framing economic analysis, estimating costs of prevention programs, estimating benefits of prevention programs, implementing summary metrics, handling uncertainty in estimates, and reporting findings. Topics for research in economic analysis are identified. The SPR Board of Directors endorses the “Standards of Evidence for Conducting and Reporting Economic Evaluations in Prevention Science.”
Electronic supplementary material
The online version of this article (10.1007/s11121-017-0858-1) contains supplementary material, which is available to authorized users.
... While the use of economic evaluation is a valuable complement to other evaluation methods, it can at times be limited by certain ethical considerations (Crowley et al., 2013;Foster, Porter, Ayers, Kaplan & Sandler, 2007). In particular, it can be difficult to place a dollar value (i.e., monetize) on all of the inputs (i.e., costs) and outputs (i.e., benefits) of community interventions (Haddix, Teutsch & Corso, 2003). ...
Restricted public budgets and increasing efforts to link the impact of community interventions to public savings have increased the use of economic evaluation. While this type of evaluation can be important for program planning, it also raises important ethical issues about how we value the time of local stakeholders who support community interventions. In particular, researchers navigate issues of scientific accuracy, institutional inequality, and research utility in their pursuit of even basic cost estimates. We provide an example of how we confronted these issues when estimating the costs of a large-scale community-based intervention. Principles for valuing community members’ time and conducting economic evaluations of community programs are discussed.
... Thus, at least among girls, improvements in these aspects of emotion regulation, coping, and decision making helped to generate meaningful reductions in externalizing. The estimated cost of the FBP in a natural delivery setting is approximately $1,763 per family or $653 per person (Foster, Porter, Ayers, Kaplan, & Sandler, 2007). ...
Research on executive control during the teenage years points to shortfalls in emotion regulation, coping, and decision making as three linked capabilities associated with youth's externalizing behavior problems. Evidence gleaned from a detailed review of the literature makes clear that improvement of all three capabilities is critical to help young people better navigate challenges and prevent or reduce externalizing and related problems. Moreover, interventions can successfully improve these three capabilities and have been found to produce behavioral improvements with real-world significance. Examples of how successful interventions remediate more than one of these capabilities are provided. Future directions in research and practice are also proposed to move the field toward the development of more comprehensive programs for adolescents to foster their integration.
